Pure alexia (PA) is an acquired reading disorder following lesions to left ventral temporo-occipital cortex. Patients with PA read slowly but correctly, and show an abnormal effect of word length on RTs. However, it is unclear how pure alexia may affect musical notation reading. We report a pure alexic patient, KH, who was a highly skilled amateur musician before a stroke that resulted in PA (elevated reading RTs; word length effect; intact writing and language) and right hemianopia. KH experienced difficulties in note reading and playing by notes post-stroke. KH's visual short-term memory capacity was intact in the left visual field.1 We investigated KH's letter and note reading using simultaneous matching tasks with stimuli presented slightly to the left of fixation. KH was compared to 9 controls matched for age, education, and music reading experience, using single case statistics2. Accuracy was high in all experiments for KH and controls, but KHs RTs were elevated in some conditions: He showed significant deficits in matching words and pseudowords, but not unrelated letters. For musical notes, KH performed worse than controls when matching the pitch of four-note sequences. In a task where both pitch and duration information was present, KH was disproportionately slower in selectively attending to the pitch of single notes, particularly on match trials, while he performed normally when selectively attending to duration information. The exact same stimuli were used in both conditions, suggesting that KHs performance cannot be explained by a deficit in basic processing of visual features of musical notes or preferences in processing strategies. In sum, pure alexia may affect music reading selectively on pitch processing, in particular with longer music sequences, suggesting an impairment in judging relative position of the notes. 1 Petersen et al. (2016). Neuropsychologia, 92;79-89.2 Crawford & Garthwaite (2002) Neuropsychologia, 40;1196-1208.